ICTworks

Leveraging online and mobile platforms to deliver HIV services was a “white elephant” in Angola. It was totally unrealistic given the local context, such as the high mobile data costs, low internet penetration, and competing priorities of communities affected by HIV.

Angola is no South Africa when it comes to internet and social media use. Forty percent of South Africans use social media, whereas only 11% of Angolans do. Community members on the front lines of the HIV response in Angola were no strangers to change. However, by early 2019 they remained hesitant to embrace the LINKAGES project’s vision of going online to accelerate the impact of HIV programs.

On the other hand, with an ambitious goal to end the AIDS epidemic by 2030, and the increasing mobile and social media use globally, this white elephant was also the “elephant in the room.” Something needed to be done to modernize HIV services for the mobile generation.

Within four months, we translated global technologies for the Angola context and found success within our program for gay men and other men who have sex with men (MSM) in Luanda. This is how we did it.

We learned about our online target audiences

Despite the challenging digital landscape, our program constituents commonly claimed that men were increasingly meeting sexual partners and making friends online through Facebook and WhatsApp. Many said they used Facebook Zero, a version of Facebook without images, GIFs, and videos that does not carry mobile data charges on Angola’s Unitel mobile network.

Thankfully, we conducted our own mapping exercise in March 2018 that identified 64 Facebook groups where gay men and other MSM could be reached with a combined total membership of roughly 280,000 profiles. We reviewed these data with our peer educators to justify to them that they should at least try online outreach.

We experimented with implementing an online outreach

Peer educators hired by LINKAGES in Angola began reaching clients online, armed with more awareness of the online audience, new smartphones, and mobile data packages. Their goal was to help their online clients access offline HIV testing services. Yet, in the first months (from January to March 2019), the peer educators were not able to bring a single client in for health services. What happened?

Well, they received a lot of nude photos from clients, they started lots of one-way conversations, and we all smacked our phones on our head a few times.

We professionalized the outreach approach

When supporting clients online, we learned that community affiliation was not enough, particularly for supporting HIV service delivery among already highly stigmatized gay men. Our online peer educators had to strike a delicate balance between having a strong community affiliation but also maintaining their professional presence and support role.

The team decided to change their approach with the following inputs:

• Training: Online peer educators were trained to use a social network outreach strategy that guided them on how to start and maintain online conversations and how to generate demand for their services through public social media posts.
• Communication tools: Messages were translated and adapted to the program context so that peer educators could quickly provide accurate responses to clients’ common questions.
• Professional profiles: Peer educators developed professional profiles on Facebook and other platforms that clearly described their work and the sexual health services they could offer clients. These profiles helped them establish trust and move past drawn-out conversations with clients seeking sex or companionship online.

Challenges still occur. Staff are asked for sex, and they sometimes face threats and other forms of harassment. The difference now is that they are better equipped to deal with these instances so that they keep the bond with the client but also stay safe.

Online efforts achieved real-world results

The program reported that 87 clients who were originally reached online arrived at clinics between April and August 2019. Among them, 74 were tested for HIV and 16% were diagnosed with HIV. Compared to a 1% case-finding rate for HIV testing among gay men reached through physical outreach, the early data suggest online outreach is considerably more targeted and efficient.

Now these may seem like small numbers, but in the context of traditional HIV outreach programs for gay men in Angola, they are sizable. For instance, the individuals diagnosed as a result of the five online peer educators accounted for 36% of all HIV-positive cases detected among gay men by LINKAGES from April to August 2019.

By carefully adapting a global approach to the local context, Angola’s small program was able to show success by leveraging online and mobile platforms for HIV service delivery… in one of the most unlikely places! The LINKAGES project in Angola closed at the end of September 2019 and the team of online outreach workers on this project will disband. However, peer educators of another local LGBTIQ NGO have been trained on the same approaches to support HIV services to online gay men and other MSM in Angola.

By Ben Eveslage, FHI 360; Rafaela Egg, LINKAGES Angola; Denizia Pinto, LINKAGES Angola; and Caitlin Loehr, IntraHealth on the LINKAGES global HIV project funded byUSAID and PEPFAR. Original published as How an HIV program in Angola went online, against all odds